Brief Answer:
Detailed history and investigations to plan proper treatment

Detailed Answer:
Hi.
Thanks for your query and history, albeit very short and specific.

To recapitulate: Male / 37 has runny nose and severe cold - no effect on Montek LC or Allercet - currently no allergies except cold.

I would like to ask a few questions to add to my knowledge, please provide the answers:
- Since when have you got this problem ?
- Is this seasonal or all around the year ?
- We consider three factors in combination and give the rating as
mild / moderate / severe viz:
1) Sneezing
2) Watering- nasal discharge
3) Nasal Blockage.
- Diabetes or any other medical problems like asthma, bronchitis or any other ?

These points will help me a lot to guide you further.
As a general rule in such patients with similar problems I would advise the following:
- Clinical Check-up by an ENT Surgeon, preferably doing an ENT Endoscopy to see the nose and to see the sequel or complications that can be caused in the ears and throat.
- CT scan of the PNS (Nose and Para-nasal Sinuses). This again helps to see any primary or secondary effects in the nose and the sinuses, any associated deviation of septum and so on.
- Blood tests particularly to see the Hemoglobin and blood sugar (if Steroids are required)
- Since you have already taken the Montek LC and Allercet, you may have to take additional treatment as per the detailed history and findings on investigations.
- I may add
Topical or oral steroid in low dosage,
antibiotic if evidence of infection is present and this is not uncommon,
Topical and oral decongestants,
mild anxiolytic if any evidence of stress or anxiety.
Vitamin A and D in therapeutic dosage and to be continued in the form of anti-oxidants (multi-vitamins).
Any other medicines as may be necessary.

In addition you have to take care:
Avoid all such places, foods, beverages, dusts, fumes, chemicals, deodorants, scents, Dhoop-battis and anything you have noticed to increase your problems.

I hope this answer helps you, as it helps all my patients.
Please feel free to give feedback, ask for any further relevant queries if needed or if you feel there is a gap-of-communication.

Dr T Chandrakant
ENT and General Surgeon
http://bit.ly/askdrtchandrakant

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Brief Answer:
Please discuss with your treating Doctor, understand the concept

Detailed Answer:
Thanks for your feedback.
Great ! Nice to know that you do not have any problems like diabetes.

This looks to be seasonal and not perennial.
Out of the three cardinal symptoms, it is Nasal discharge that is causing more trouble.
Sneezing and Nasal blockage are mild, but present.

I would advise you the following in such a patient:
-First of all, please remember that this is the most suggestive treatment as per my experience.
-Every patient needs the titration of the dosages in such a way that the minimum most level of medicines should have the maximum benefit.
-At some occasion the dose may need to be increased and if the symptoms are reducing, start reducing the dosage in such a way that at one time you may not that particular dose for a longer time.
-The treatment is aimed at giving the most comfortable life with most minimum dosages.
-Over the time, all the patients understand when they should take a particular single or combined medicines, and when not. With time, the number of medicines and the dosage and frequency all reduce dramatically. Many a patients can start enjoying those things which they had to avoid o keep the symptoms at bay.

The specific treatment:
For this you have to discuss with your Family Doctor and / or the ENT Surgeon, get a valid prescription as many of the medicines are Prescription drugs needing a prescription on paper as I may not be in a position to give a prescription over net.

-Steroidal nasal sprays containing Mometasome or Fluticasone. These are available with metered dosage and need to be used once a day only. Over time you can start using only when required.

-Decongestant nasal sprays like Xylometazoline, to be used only when nasal blockage is present.

-Oral Steroids: The initial treatment is always in a tapering dosage over 15 to 21 days. This means if you are taking say 3 dosages to start with say for 5 days, the next schedule will be 2 dosage over the next day 6 to day 10 and the next schedule will be dose 1 only over day 11 to 15.
I hope, you can understand what I mean by.
As the dosages are reduced the nasal sprays take over the treatment reducing the risks, yet making the life very comfortable.
One time comes when you are almost off all the medicines needing a few tablets or sprays only if required.
By this time you come to know usage of the most minimum of dosages of all the medicines and which medicines suits you the most.

-Antihistamines : You were / are already using Montek LC and Allercet. There are varieties of medicines ranging from the age-old Avil to the newer once like Cetirizine et al. You have try one by one and see which suits you the most in regards to effectiveness, not giving sedation and need to use once in a day or 2.

- Role of a mild anxiolytic or anti-depressant is definitely there and you need to discuss this with your treating Doctor

-Vitamin A can be taken to have a dose of 1 to 3 lac units (if 30,000 unit capsules are available, please check with your Doctor and / or the Medical shop)
Vitamin D3 is available in XXXXXXX form and you can take 1 XXXXXXX every week for 3 weeks.
Continue with anti-oxidants available as multivitamin capsules.

-Ultimately the combination and permutations under the guidance of your treating Doctor and your own observations all help you to have almost symptom-free life with the most minimum of medicines.

I hope this answer helps you well, I humbly request you to discuss these medicines, combinations, reducing the dosages with your Doctor so as not to have any confusion.

I always there to assist you in the allowable frame.
Please feel free to discuss.
I am sure once you start this regimen, you are sure to have a great relief in the most minimum of dosages.

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